Asthma and sickle cell disease: two distinct diseases or part of the same process?
Asthma and sickle cell disease: two distinct diseases or part of the same process?
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DOI：
10.1182/asheducation-2009.1.45
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发表时间：
2009-01-01
期刊：
影响因子：
--
通讯作者：
DeBaun, Michael R
中科院分区：
文献类型：
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作者：
Field, Joshua J;DeBaun, Michael R
医生诊断患有镰状细胞病（SCD）的儿童和成人哮喘与疼痛和急性胸部综合征（ACS）发作和过早死亡的发生率增加有关。尽管医生对SCD患者的哮喘诊断具有临床意义，但医生诊断哮喘的标准尚未明确。哮喘的许多特征在SCD患者中很常见，包括喘息、阻塞性肺病和气道高反应性症状。然而，尚不清楚这些哮喘的体征和症状是否反映了哮喘的医生诊断，或者这些哮喘特征是否与SCD有关。SCD儿童哮喘诊断的进一步复杂化是哮喘急性发作和ACS发作之间临床表现的显著重叠。支持哮喘和SCD是单独的共病疾病这一概念的证据包括SCD儿童和普通人群中哮喘的患病率相似，以及观察到哮喘在SCD儿童家庭中以家族模式遗传。相反，有显著证据表明，哮喘样特征可能与SCD相关，但未诊断为哮喘，包括气道高反应性和阻塞性肺疾病的患病率高于预期。无论SCD和哮喘是不同的还是重叠的共病，我们建议在怀疑诊断或患者有多次疼痛或ACS发作时对哮喘进行系统和完整的评估。
A physician diagnosis of asthma in children and adults with sickle cell disease (SCD) has been associated with increased rates of pain and acute chest syndrome (ACS) episodes and premature death. Despite the clinical significance of a doctor's diagnosis of asthma in individuals with SCD, the criteria for a physician diagnosis of asthma are not well defined. Many features of asthma are common in individuals with SCD, including symptoms of wheezing, obstructive lung disease and airway hyper-responsiveness. However, it is not clear if these signs and symptoms of asthma reflect a physician diagnosis of asthma, or if these asthma features are related to SCD. Further complicating the diagnosis of asthma in children with SCD is the significant overlap in clinical manifestations between an asthma exacerbation and an ACS episode. Evidence supporting the concept that asthma and SCD are separate co-morbid conditions includes a similar prevalence of asthma between children with SCD and those in the general population and the observation that asthma is inherited in a familial pattern in the families of children with SCD. In contrast, there is significant evidence that asthma-like features may be associated with SCD without a diagnosis of asthma, including a higher than expected prevalence of airway hyper-responsiveness and obstructive lung disease. Regardless of whether SCD and asthma are distinct or overlapping co-morbid conditions, we recommend a systematic and complete evaluation of asthma when the diagnosis is suspected or when patients have multiple episodes of pain or ACS.